Legislature(2017 - 2018)CAPITOL 106
03/29/2018 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB193 | |
| SB174 | |
| SB108 | |
| Confirmation Hearing(s) | |
| HB358 | |
| HJR32 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 174 | TELECONFERENCED | |
| += | SB 108 | TELECONFERENCED | |
| += | HB 358 | TELECONFERENCED | |
| *+ | HJR 32 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 193 | TELECONFERENCED | |
HB 358-INSURANCE COVERAGE FOR TELEHEALTH
4:48:11 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be HOUSE BILL NO. 358, "An Act relating to insurance coverage
for benefits provided through telehealth; and providing for an
effective date."
4:48:22 PM
BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, declared that there had not been any
opposition to the proposed bill and she paraphrased from the
Sectional Analysis [Included in members' packets], which read:
Section 1.
AS 21.42.422 has been amended to require insurance
coverage for benefits provided via telehealth.
Section 2.
AS 21.42.422 is a new subsection that defines health
care insurer as a person transacting the business of
health care insurance except for a nonfederal
governmental plan. It also adds the definition of
telehealth under 47.05.270(e) as the practice of
health care delivery, evaluation, diagnosis,
consultation, or treatment, using the transfer of
health care data through audio, visual, or data
communications, performed over two or more locations
between providers who are physically separated from
the recipient or from each other or between a provider
and a recipient who are physically separated from each
other.
Section 3
The changes to Section 1 of this bill applies to
health care insurance plans that are offered, issued,
delivered, or renewed on or after the effective date.
Section 4
The effective date is July 1, 2019.
4:49:44 PM
CHAIR SPOHNHOLZ opened invited testimony on HB 358.
4:49:54 PM
AROM EVANS, MD, Medical Director, Orion Behavioral Health
Network, stated support for the proposed bill, pointing out that
telemedicine was an extremely important service for many
residents of rural villages as it was not realistic to have a
psychiatrist reside in these communities. He pointed out that
sometimes private insurance did not pay for telehealth,
resulting in difficulties for many patients. He stated that
neglect of mental health issues tended to drive up health care
costs, and that payment by private insurers for telehealth would
save money for the state.
4:53:19 PM
REPRESENTATIVE ZULKOSKY asked if the Orion Behavioral Health
Network partnered with Alaska providers who had encountered this
challenge.
DR. EVANS explained that there were Alaska providers in their
network and they had encountered difficulties in getting
services paid for both in and out of state providers.
4:55:08 PM
LYN FREEMAN, Ph.D., Mind Matters Research, declared her support
for the proposed bill. She shared some background for her
practice, stating that she treated patients who were referred to
her with chronic disease and behavioral or emotional issues
which contributed to a worsening of the condition. She
practiced various forms of integrative approaches, including
non-pharmalogical pain management. She reported that about 40
percent of her practice was through tele-health as travel was
not possible for these patients. She reported that she had
tested her research for psychological interventions for patients
with chronic diseases through both live delivery and tele-
health, and that improvement outcome was equivalent for both
systems of delivery. She shared that she had maintained
training for the ethical aspect in the use of telehealth for
mental health treatment. She reported that these ethics
trainings had pointed out that it was preferable to treat people
in your own state as it was easier to know the resources
available should something happen during the distance
treatments.
4:59:30 PM
CHAIR SPOHNHOLZ opened public testimony and after determining no
one wished to testify, closed public testimony on HB 358.
4:59:56 PM
REPRESENTATIVE EASTMAN asked about the scope of the benefits
being provided.
5:00:48 PM
CHAIR SPOHNHOLZ, as the sponsor of HB 358, clarified that
receiving medical care via telehealth did not mean not seeing a
doctor. As telehealth was a delivery system, it was not
necessary to limit the scope in the proposed bill. She shared
that she did not want to put limits on the creativity of health
care providers based on the current ability to imagine what can
and cannot be done, and that this would allow the marketplace to
develop.
5:01:53 PM
REPRESENTATIVE EASTMAN asked if this meant that any benefits a
health care insurer provided coverage for should also be covered
via telehealth.
CHAIR SPOHNHOLZ emphasized that this was intentionally broad,
and that this was based on her own experiences for not being
able to access health care services via telehealth. This led to
the exploration of the concept of telehealth as it related to
private insurance. She stated that, as not all health care
insurers would currently pay for this, it was time to move in
that direction.
5:03:12 PM
VICTORIA KNAPP, Chief Operating Officer, Mat-Su Health Services,
stated that she was in support of HB 358. She reported that
several years ago Mat-Su Health Services had moved to a tele-
medicine model for some of their psychiatric evaluations and
medication management appointments to meet some of the unmet
need for these services in the borough. She declared that they
were a safety net provider, funded by the federal government and
the Division of Behavioral Health. She shared that, as several
large insurance providers in the state did not provide coverage
for tele-health services, families and individuals were left
with the choice of a very large bill or looking elsewhere for
psychiatry services. She declared frustration that these
insurers did not cover tele-health psychiatry.
5:05:24 PM
REPRESENTATIVE ZULKOSKY moved to report HB 358, Version 30-
LS1216\J, out of committee with individual recommendations and
the attached zero fiscal notes.
5:05:37 PM
REPRESENTATIVE EASTMAN objected. He explained that all his U.S.
Department of Veterans Affairs health care through his primary
care doctor in Orlando, Florida, was via tele-health. He stated
his appreciation for the value, and opined that, although there
were cost savings to be gained, the market was not ready for a
mandate that any provided health care also be accessible via
tele-health. He offered his belief that, if it made financial
sense, providers would go that direction. He stated that
telehealth was not everything it could be, and that the
providers should have the option to not have to use it.
5:07:12 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if there was a list of
what was approved for telehealth medicine for procedures and
oversight for patients.
5:07:39 PM
MS. NISBETT said that there was a list of procedures on the
Alaska Native Medical Center website that were accepted.
CHAIR SPOHNHOLZ pointed out that this was a different category.
5:08:16 PM
ANNA LATHAM, Deputy Director, Division of Insurance, Department
of Commerce, Community & Economic Development, clarified that
the proposed bill allowed for insurance companies to pay for
telehealth services in both the group and individual markets.
She stated that the benefits that were already in the plans for
essential health benefits, as well as any other benefits covered
by the plan, would be allowable for telehealth. She stated that
the list of benefits for the Alaska Native Health plans was a
separate program.
5:09:06 PM
REPRESENTATIVE ZULKOSKY asked whether the proposed bill mandated
that an individual utilize telehealth services, or whether it
just provided the authorization for the insurance plans to be
billed for those services.
MS. LATHAM replied that there was not a mandate, that it allowed
the insurance companies to cover telehealth services beyond
mental health, which was currently in statute.
5:09:37 PM
REPRESENTATIVE EASTMAN asked whether a current benefit from a
health care plan would now also be provided as a telehealth
option.
MS. LATHAM explained that, with the proposed bill, the insurer
can pay if you utilize telehealth.
5:10:11 PM
REPRESENTATIVE EASTMAN asked about the definition of shall in
this specific context.
5:10:32 PM
MS. LATHAM explained that the proposed billed stated that the
insurers shall provide coverage for benefits provided through
telehealth. This may or may not require in-person contact.
This proposed bill simply allowed large, small group, and
individual market coverage to pay for telehealth services.
CHAIR SPOHNHOLZ asked for clarification that the proposed bill
was not requiring people to use telehealth, but it was requiring
insurance companies to cover telehealth services should the plan
have a provision for such services. She acknowledged that there
were some services which did not make sense for delivery via
telehealth. She pointed out that there were a lot of insurance
plans offered in the State of Alaska which were not required to
cover telehealth. She stated that this bill was not saying what
kind of health care should be covered by telehealth, it was
saying that the insurance provider should pay for the service if
it was delivered via telehealth.
5:12:41 PM
REPRESENTATIVE EASTMAN asked where he could go to find out what
services were available by telehealth. He asked if one insurer
decided to provide a benefit via telehealth, did all the other
insurers need to match.
CHAIR SPOHNHOLZ said that was a decision between him and his
health care provider.
5:13:21 PM
REPRESENTATIVE EASTMAN maintained his objection.
5:13:27 PM
A roll call vote was taken. Representatives Spohnholz, Tarr,
Sullivan-Leonard, Johnston, Zulkosky, and Kito voted in favor of
HB 358. Representatives Eastman voted against it. Therefore,
HB 358 was reported out of the House Health and Social Services
Standing Committee by a vote of 6 yeas - 1 nay.